Life is tough when you’re a 22 year-old analyst working through the night. But life could be tougher when you’re a 31 year-old VP with three 22 year-old analysts working nights for you. Just because you’re older and richer, life does not necessarily get any easier.

“There’s an epidemic of cocaine and alcohol use among 30-something bankers in the City,” says Mark Dempster, an author and Harley Street addiction specialist. “It’s almost normalized. For many people it starts in their 20s, but becomes critical in their 30s as their income increases and the drugs become more affordable. – People are self-medicating to cope with the stress.”

Dempster is counselling eight bankers in their 30s. This doesn’t exactly constitute an epidemic, but Dempster says his eight are representative. Dr. Michael Sinclair, a psychologist specializing in City workers, seconds his claims: “A lot of the work culture in banking revolves around drinking or drug taking,” says Sinclair. 10 years in, this exacts a toll.

HR professionals in banks are aware of the particular cocktail of stresses that affects the middle ranks. “It’s when you’re a vice president or director that your career options really start to crystallize,” says one head of HR at an international bank, speaking on condition of anonymity. “As a director, you need to be moving towards become a proper revenue generator. If not, you will not get promoted to managing director and your career may be cut short.”

It’s this “up or out” mentality that fuels stress among 30-something finance professionals. Some banks allow for ‘career directors'”, says the head of HR. These are ‘subject matter experts’ rather than revenue generators, but they’re rare and the subject matter they’re an expert in needs to be very niche if they’re to last. Most VPs and directors need instead to focus on generating revenue streams for the bank – and this isn’t easy.

“It’s gotten harder to monetize relationships,” says the head of one investment banking recruitment firm in the City. “It’s also become harder to get promoted to managing director.”

At Goldman Sachs, for example, MD promotions now happen once every two years instead of annually. At Nomura, just 15 people were promoted to MD in London this year. If you want to make it to the top in banking, you’ll need to play a long game: think 17 years, of which half can be spent jockeying for position in the mid-ranks.

Sinclair says the 30-something finance professionals who visit him have issues that extend beyond symptomatic addictions. After working 100 hour weeks during their 20s, he says many have few interests outside work. Work is therefore a main source of meaning and failure to progress at work equates to an existential crisis. “When they do not get a promotion or bonus, they can feel a tremendous sense of failure and rejection and life can seem pretty meaningless.”

Conversely, Sinclair says 33 year-old bankers with families outside work come to him because they feel compromised. “It’s difficult to juggle personal values and commitments with the demands placed upon them in an occupational context….They feel a perpetual fear of letting people down.”

Vice president salaries in investment banks have been hiked to around £150k ($237k) in London. The head of HR says this has taken the sting out the cost of living in London, but that mid-ranking professionals with growing families are still under financial pressure – especially in the ‘keeping up with the Joneses’ culture of banking. “If you’re a career director, you’ll need to make lifestyle compromises,” she says. – You won’t be able to live in Zone One, to have your children privately educated, or to take multiple holidays to Mauritius. For most people, this doesn’t matter, but social signals are important in banking. Anthropologist and journalist Joris Luyendijk, says senior bankers feel a need to “project success in the way that they live.” This means taking the right holidays, paying for the right schools, wearing the right watches.

To cap matters off, recruiters suggest that the increase in mid-level salaries has also make 30-something bankers more vulnerable to redundancy. “One vice president now costs the same as three analysts,” says Logan Naidu, chief executive of recruitment firm Dartmouth Partners. “That’s a lot of overhead when the market changes and firms look at costs rather than growth.”